Case report: Blotchy skin in a puffy neonate: is there a new association?

IntroductionPurpura fulminans in the neonatal population is a rare but potentially life-threatening condition complicated by thrombosis, resultant vital organ necrosis, and gangrene of the extremities. Considering the rapid evolution of the pathogenetic mechanism, an index of suspicion, early identification, and prompt intervention are imperative for improved outcomes. The majority of purpura fulminans cases have an infectious etiology, but it is essential to consider other congenital and acquired causes.Case descriptionWe present a clinical case of a female neonate to emphasize the correlation between purpura fulminans, congenital chylothorax, involvement of the PAK2 gene, and the occurrence of retinal detachment in both eyes. After draining the congenital chylothorax, the neonate developed purpura fulminans due to a loss of protein C, S, and antithrombin factors, previously not reported in the literature. The purpuric lesions resolved after the administration of fresh frozen plasma. Subsequently, no recurring purpura fulminans lesions were noted following the normalization of the antithrombotic factor levels in the serum. Subsequently, the child also developed retinal detachment in both eyes

Examination for Retinopathy of Prematurity in Premature Neonates and Feeding

Introduction: Retinopathy of prematurity (ROP) affecting developing retinal blood vessels in premature neonates may lead to poor visual activity or blindness. ROP occurs in 50% of neonates and 8% develop severe ROP, requiring treatment. Eye drops for dilating the pupils for examination of the eyes can be absorbed and consequently impair gut motility. Eye examinations may be associated with pain and adverse physiological effects including apnea, which cause parental distress. Objective: To examine the relationship between feeding intolerance 24 hours before and after eye examination for ROP. Method: Retrospective audit was conducted in preterm infants undergoing ROP examination. Feeding intolerance and apnea were observed 24 hours before and 24 hours after eye examination. Results: A total of 18 infants (mean birth gestational age=25.4weeks ±1.5 weeks, mean birth weight=799g ±290g) with 57 eye examinations were included. We observed a significant increase in feeding intolerance in the form of pre-feed aspirate after eye examination (5.2% versus 23%) and suspension of feed (0% versus 5.2%). Two infants were kept nil per oral following eye examination.  Conclusion: Eye examination for ROP screening was associated with feeding intolerance in preterm neonates. * Indicates faculty mento

The mystery of persistent pulmonary hypertension: an idiopathic infantile arterial calcification

BACKGROUND: Idiopathic infantile arterial calcification (IIAC) is a rare autosomal recessive disorder, characterized by wide spread calcifications in arterial walls, leading to vaso-occlusive ischaemia of multiple organs. Mortality is high, and there is no definitive treatment. CASE PRESENTATION: A male neonate, 36(+5) weeks gestation, 2.81 kg, was admitted to NICU for respiratory distress. At one hour of age, he was noted to be pale, hypoperfused, with weak pulses, a hyperdynamic precordium and a grade IV/VI pansystolic murmur. The rest of his examination was normal. A chest X-ray showed massive cardiomegaly and pulmonary oedema. An echocardiogram (ECHO) indicated moderate persistent pulmonary hypertension (PPHN) of unclear etiology. A diagnosis of Idiopathic infantile arterial calcification was made and a trial of Editronate therapy was given without success. CONCLUSION: IIAC is a rare disorder, it should be considered whenever a neonate presents with unexplainable cardiac failure, PPHN, echogenic vessels on X-ray/ultrasound and, or concentric hypertrophic ventricles on ECHO. Serial antenatal ultrasound findings of echogenic cardiac foci should raise the suspicion of IIAC. Further studies to determine the long term effects of Editronate on vascular calcifications, disease outcome, and other treatment options are needed